Duration of Resuscitation Efforts and Functional Outcome After Out-of-Hospital Cardiac Arrest

Abstract

Background Functionally favorable survival remains low after out-of-hospital cardiac arrest (OHCA). When initial interventions fail to achieve return of spontaneous circulation (ROSC), they are repeated with little incremental benefit. Patients without rapid ROSC do not typically survive with good functional outcome. Novel approaches to OHCA have yielded functionally favorable survival in patients who failed traditional measures, but the optimal transition point from traditional measures to novel therapies is ill defined. Our objective was to estimate the dynamic probability of survival and functional recovery as a function of resuscitation effort duration, in order to identify this transition point. Methods and Results Retrospective cohort study of a cardiac arrest database at a single site. We included 1,014 adult (≥18 years) patients suffering non-traumatic OHCA between 2005–2011, defined as receiving CPR or defibrillation from a professional provider. We stratified by functional outcome at hospital discharge (modified Rankin scale–mRS). Survival to hospital discharge was 11%, but only 6% had mRS 0–3. Within 16.1 minutes of CPR, 89.7% (95%CI: 80.3%, 95.8%) of patients with good functional outcome had achieved ROSC, and the probability of good functional recovery fell to 1%. Adjusting for prehospital and inpatient covariates, CPR duration (minutes) is independently associated with favorable functional status at hospital discharge (OR 0.84; 95%CI 0.72, 0.98;p=0.02). Conclusions Probability of survival to hospital discharge with mRS 0–3 declines rapidly with each minute of CPR. Novel strategies should be tested early after cardiac arrest rather than after complete failure of traditional measures.

Potential Candidates for a Structured Canadian ECPR Program for Out-of-Hospital Cardiac Arrest

“…[5][6][7][8][9] While no prospective randomized studies have been completed examining the outcomes of ECPRtreated patients in comparison to conventional resuscitation, ECPR for OHCA is typically initiated between 45 and 75 minutes after the initial cardiac arrest, 6,7 an elapsed duration of resuscitation at which survival with conventional resuscitation appears to be rare. 17 The Alfred Hospital and Victorian EMS system in Melbourne, Australia, which provides similar hospital and pre-hospital services to those in our region, recently described the results of an ECPR protocol, demonstrating 56% neurologically intact survival in a carefully selected group of patients with refractory OHCA treated with ECPR. 7 Based on these data and other similar studies, assuming a survival rate of 30%-55% of those in refractory cardiac arrest treated with ECPR, [6][7][8] among the 54 potential ECPR candidates in our cohort who remained pulseless after conventional resuscitation, it is possible that an additional 16-30 patients (four …”

“…We designed an electronic data collection tool with variables chosen a priori in consideration of Utstein variables, 16 variables with known associations with outcomes in cardiac arrest, 17 and variables to describe the patient population. All pre-hospital data, including time-stamped diagnostics, treatments administered, patient characteristics, and pre-hospital outcomes, were prospectively collected from standardized EMS template charting.…”

Accuracy of Nasal Nitric Oxide Measurement as a Diagnostic Test for Primary Ciliary Dyskinesia: A Systematic Review and Meta-Analysis

“…19,21 The effectiveness should be compared to early transport under high-quality ongoing resuscitation and ECPR institution after arrival to the hospital. Novel therapies are in evolution 43,44 to enhance cardiac and neurological recovery (Table 2), including percutaneous coronary intervention, intraaortic balloon pump, thrombolysis and targeted temperature management. When offered during or early after resuscitation attempts, results were encouraging.…”

Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest

“…The secondary outcome was survival with favorable neurologic status at discharge, defined as a score on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) of 3 or less, indicating the ability to conduct daily activities independently or with minimal assistance. 18 These outcomes were determined in both the per-protocol population (the primary analysis) and in the intention-to-treat population.…”